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SJ COUNTY PHS-ENVIRONMENTAL HEALTH DIVIS11, MASTERFILE RF 'D INFORMATION FORM(EH 00 591R..le+a 81941) <br /> N E71 P 9 IEx t 9 F IrtY N EH P g /N F 'IkY Dale <br /> S� 3 <br /> SHADED SECTIONS FOR LOCAL USE ONLY yy <br /> FACILITY ID # <br /> �70 RECORD ID # <br /> Fla...Mark the Appropriate Description and Specify S¢e e �r Numbs f UirNe where applicable: <br /> DAIRY PROGRAM {2000} ''9l �D �' <br /> D a aD'y <br /> G d B D l I Milk Dim.mn I Number of,-anomer.to Mulct.Herid UOR <br /> _FOOD PROGRAM {1600} <br /> I south,C.P.dtr 1 sir....Feetap. produce Stand Ice Plant <br /> Restaurant <br /> Number of UNb <br /> I Dry Storage only 1 with Food Preparnaon VendingMachines <br /> Commissary <br /> I Square Footega I with Meet Market ought 1 with Food Preparedon I Ory Goode only <br /> Retail Market <br /> I1 Ragletretlon• I Ucen.e! <br /> t M.ke I Vallote Type I color I I <br /> =Food I 1 <br /> II color <br /> I Posteriori..I I Uoanee N <br /> Make Vehicle Type 1 I I <br /> Mobile Food Unit 1 <br /> FTe,-,p-,.Pl.y Food Facility Special Event <br /> of OM6uu <br /> from <br /> to Date.of op.ra6on from 'o <br /> _HAZARDOUS WASTE PROGRAM {2200} <br /> I Tone swwraed per year <br /> Hazardous Waste Generator <br /> If categorically pelly eumo :. cuawlkugy EI Permit by Rule <br /> Tiered Permit Facility <br /> _ HOUSING PROGRAM {2400} EMPLOYEE HOUSING {2700} <br /> I Number of UNb Number of Employees OMry Employee Howins <br /> Hotel/Motel <br /> Approamm. Dobe of oopnpanpr to <br /> Jail or Exempt Institution <br /> _LIOUID WASTE PROGRAM 4200} <br /> i Regbtretlon A I Ucenee/ 1 C....ly, 1 vehicle <br /> Pum er Vehicle <br /> Number of flight,pumper Yard Pucka a Treatment Plant Chemical Toilets <br /> _MEDICAL WASTE PROGRAM (4 001 <br /> PrimaryCare Acute Care Skilled NurSinSI Large Generator <br /> Small Generator Transfer Station Limited Hauler Veterinary Clinic <br /> 1 2-1 o generators 11 -So ewe recon >So swroure e <br /> Common Storage Facility <br /> _RECREATIONAL HEALTH PROGRAM {3600} <br /> Pool Sort, Out of Service Pool/Spa Natural Bathing Area <br /> Number of P.O./Spier,at Fooilm, Poollspa 10 a <br /> _SRE MITIGATION PROGRAM {2900} <br /> Environmental <br /> Assessment UST/CAP Local Haz Waste Haz Mat Pipeline <br /> I Cd EPA-PNi f Cal EPA-OTSC I US-EPA <br /> Other Lead Agency Site <br /> 1 NPL Site 1 Water Quality sit. I Other <br /> SOLID WASTE PROGRAM {4400} <br /> Landfill Transler Station A /Canner Waste Site <br /> Utility <br /> CIA Landfill Site Sludge/Ash Site Compost Facility Refuse VehicleLcuYd9;EJ <br /> Waste Tire Facility Process/Recycle FacilityDum stere >2 <br /> _VECTOR CONTROL PROGRAM {4000} <br /> Modruin Number of Bird. Kennel <br /> PoWtry Farm <br /> Fme"mur Notlfice lon for the FACILITY end/or MOOR" Dey Night <br /> CONTACT PERSON: M(( _ %-cy NINE <br /> Designabd Enployae R Pollem Dem 9N _ r- cmu Stntu. Number of Unib EPA ID I", O ,e n, <br /> ewwa. y eb eviewe y Det. _,,'i ng 0 fire Dum ullitcle, r uta .t to ate <br />